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Saturday, July 7, 2012

#410: Bleeding, Burning, and a Visit From Dr Rubber Fingers

See, this is the kind of post Mrs P is always warning me not to write. Mum hates it when I talk about this stuff. We are going deep into the realm of Too Much Information here. Why write about it? Because you might find yourself in the same spot I did, and I want you to deal with it. Prepare yourself. It's a loooong story. Make a sandwich. On second though, you may not want to eat just yet. Here's how it all started.

Forgive the indelicate nature of this post, but I have a medical question. Anybody else have painful, bloody pee after a run? I noticed a spot on my white shorts at the gym today, and more after my workout. Obviously, I have some unique risk factors, and intend to call the doc first thing Tuesday morning, but should I be in the ER instead? I've done a little research and understand this is fairly common among runners, but if anyone on the board has had it, what did you do about it?

I posted that on May 26th in the John's Striders Facebook page. That's where my running group gets together online to share wisdom, experience, and humor (my specialty.) The consensus of the group was that this was definitely not humorous. Here was the most direct response.

I've been running for 25 years, I've run marathons and in the past 3 years I have logged thousands of long miles preparing for ultramarathons. I have lost toenails, had some pretty gnarly chaffing, puked my guts out and had all manor of GI upset. I have never seen blood in my urine and if I did my next stop would be my doctor or the ER. Respect your kidneys, have them checked out.

When a runner you respect tells you to quit screwing around and get to the doc, you do it. And so began one of my spookiest adventures since my cancer diagnosis. Cancer, and the treatment that kills it, can compromise your body in some dramatic ways, and you can never take symptoms lightly again. Blood in your urine is a big one. The condition is called Hematuria, and it means just what it sounds like... Hema (blood) in the Urea (pee). According to the American Kidney Fund, it can be caused by

Strenuous exercise

Urinary tract infections

Kidney stones

Kidney injury

Cancer in the urinary tract

Anybody else hearing alarm bells for Pennsy in that list? Yeah, me too. So I went back to see the Doc who first palpated my neck back in 2010. I told her about my symptoms and the events of the past few weeks. I ran a Marathon on May 6th. After a couple weeks rest, I had a good hard 6 miles on Saturday, and came home with painful, bloody urination. Although everything seemed to have returned to normal, my specimen on Wednesday still showed microscopic traces of blood. She poked and prodded for a while, then ordered a CT scan and referred me to the urologist. I hate visiting the urologist. No matter how nice a guy he is, sooner or later you end up with a rubber finger up your butt. I grimaced and made the appointments.

The CT scan was simple, compared to what I'm used to. No injections. No complex prep. Just plop down on the table, hold your breath, and you're done. We were looking for kidney stones, an easy catch, but the scans came back clear. When you're looking for cancer, clear scans are good news. When you're trying to find something wrong, clear scans just mean you don't have an answer yet. It was time to visit Dr Rubber Fingers.

READER DISCRETION IS ADVISED.

Ladies, if you don't want to know about this, just skip this section. Gentlemen, tough it out. You may need to hear this. The nurse took my vitals, and sent me to the bathroom toexecute what's called a clean catch.You wash your hands and wipe the little man off with an antiseptic towelette. You start the "flow," then pinch it off. This flushes out the pipes in case you have any lint or dust or spiders or anything up there. Then you point the wee fellow into a cup that is about the size of a juice glass (unfortunate but true,) and fill 'er up. When you finish, you screw a cap on the cup and wash again. Depending on the local customs, you either leave the cup on the sink, or else muster up as much dignity as you can and carry your golden vessel out to the nurse's station. While you avoid making eye contact, she takes it and sends it off to be tested. She then walks you to the exam room.

You sit alone for a while, staring at lovely multicolored posters illustrating a giant urinary system with a massive bladder, vast urethra, and testes the size of kiwi fruit. You stare at the exam table, shivering with anticipation. You look over the instruments, wondering how cold they are. When the Doc comes in, you have a distracted conversation about your symptoms and the current state of things. Then he pulls on a pair of gloves, and asks you to stand up and shuck down your drawers.

And there you are. Standing in the middle of a linoleum floor with your shorts around your ankles while a man in a lab coat studies your privates like a jeweler assessing an old engagement ring. Been a long time since anyone looked at me like that. I thing The Best of Bread was playing.

Does this mean we're going steady?

Then come the words you've been dreading. "OK, go ahead and just put your elbows on the exam table for me." He appologizes, "Sorry, the jelly is going to be a little cold." Figures. And then, before you know it, it happens.

OK, I have a confession. Don't you dare tell a soul. I'll deny it, and everyone will believe me because I'm a cancer survivor and a minor local celebrity and I've never ever heard anyone else dare to say it out loud. Here it is. I don't care how strait you are. There are bejillions of pleasure receptors down there. When someone touches your prostate... it feels kind of nice. That's probably the creepiest part of the exam. Not that there's a guy's finger poking in the back door, but that you don't completely hate it. Don't get me wrong, you're glad when it's done. But it does rattle your cage in ways nothing else can.

The weirdest part of all? My Doc... and I have since learned that med students are strictly instructed never to do this... but my Doc says, "OK, that feels pretty good." As I'm cleaning the lube off with a paper towel, I'm hoping he keeps that to himself. A gentleman doesn't tell.

We discuss my apparently healthy prostate. We've ruled out a couple more scary possibilities, but the remaining ones are worse. He schedules two more tests, designed to look for tumors in my plumbing. He wishes me well, and leaves. We don't shake hands. On the way back down the hall to the nurse's station, I have the same feeling I used to get when leaving a Times Square peep show. I am certain everyone is looking at me and knows exactly what I've been up to. I make a joke about it to the nurses, and their good humor makes it a little easier to get to the elevator, though I am certain that the lady who rides to the lobby with me is judging me the whole time.

OK, LADIES, YOU CAN START READING HERE AGAIN.

The next test is called IVP. That stands for intravenous pyelogram and it involves a series of x-rays that follow some contrast fluid as it makes its way through your bloodstream, kidneys, and bladder. It's a pretty simple procedure for the patient, although you do have to go through the same cleansing ritual required by a colonoscopy. That means consuming only clear liquids the day before, and spending the evening reluctantly drinking and explosively eliminating some industrial strength laxative brew that leaves you clean as a whistle. In fact, it actually makes you whistle by morning.

The IVP showed no signs of cancer, so there was only one test left. I had done a little research, but I was not really prepared for what was to come.

Cystoscopy: even weirder than it looks.

The picture on the left kind of says it all. You pee in a cup. You go to a waiting room. You undress and put on a robe. They put you on a gurney and roll you into a large exam room. There are three people there waiting for you. The doc tells you your x-rays look fine. The nurse who rolled your gurney locks the wheels and adjusts your pillow. The second nurse flips down your sheet, flips up your robe, and smears little Pennsy with antiseptic goo with all the tenderness of a Jiffy Lube technician checking your antifreeze. You make a little joke about the scope looking just like the one the surgeon uses to look down your throat. The doc assures you that it's the same instrument. You can't help thinking that it ought to be a lot smaller. The Jiffy Lube nurse lifts up your boy and says "this is just going to numb you a little bit, but it may burn at first." She is holding a really big syringe in her hand and you whimper without shame until you realize that the thing doesn't have a needle. It's just a little cone that she's gonna slip inside your... Whoa... OK... that puts the O in OMG. I have never felt anything like that before in my life. She pumps the stuff into me and it feels like... nope... it doesn't feel LIKE anything. I'm experiencing a completely new kind of discomfort. It doesn't hurt, exactly, but it has none of the secret, shameful pleasure of a visit from Dr. Rubber Fingers. The doc is laughing it up now. He is running with a nervous joke I made about garden hose, and starts telling me about the primitive versions of this exam, which involved metal tubes, mirrors, and presumably very tiny candles. All the while, he's holding my Johnson straight up with his left hand so the numbing goo can trickle down. He takes the scope from the nurse. It looks just a little smaller than a vacuum cleaner hose. I watch the tip as it disappears down past the sheet bunched up on my belly. And together we cross over a whole new frontier.

Now look. There are more painful things. Nearly every trip you'll ever make to the dentist will hurt more than this at one time or another. I've had ingrown toenails removed, and that hurts like anything. I once had swimmer's ear, and I wanted to die it hurt so bad. This isn't as bad as any of those things. It doesn't make you cry. But you will make faces. "OK, we're at the prostate, now. This is the hardest part," says the doc. And yeah, it is. At this point, I am positive that he should be using a smaller camera. "Great," he assures me, "I'm in the bladder now. The worst part is over." Says you, wiener man. Who the hell makes a career of doing this to people? I suddenly notice that the guy isn't watching through a monitor like my throat surgeon does. He's peeping through the back of the scope like the guy in the picture above. His face inches from me, peeping around inside my pee-pee, and I want him to be as thorough as he has to be because I never ever want to do this again. "All right," he smiles, using the same poor language choice he made when visiting the back porch, "that looks really good." Am I supposed to blush, or just smile and say "Thank You?"

He slips the scope out smoothly, and some sort of goo gushes out of me. I don't care if it's antiseptic, lube, or pee, I'm just glad the thing is out. I ask him, "so what's the deal? Why was there blood after my run?" He explains that I have some prominent blood vessels in my bladder that probably were irritated when I ran without drinking enough water. "We'll check you again in a year." I nod, while thinking, "the hell you will, pal." The gurney rolling nurse kicks off the brakes and rolls me out into the hall. Everyone is looking at me. Judging me. They know what I've been up to.

Don't judge me...

We roll down the hall to a restroom and I wrap the sheet around myself as I hop through the door. The nurse encourages me to clean myself up, urinate, and get dressed. More paper towels. One more trip to the toilet. There is a little pink in my stream, which they've told me is normal. It hurts a little, which they've also warned me about. What they didn't prepare me for was this... All that plunging and pumping and filling with goo seems to have forced some air into my thingee. For the first time in my long, experience filled life, I learn what it is like to fart through your penis. For reason's I can not explain, I find this hysterically funny. I'm standing there, naked from the waist down, peeing and tooting, tooting and peeing and laughing like an idiot.. I don't care if you believe me. That's what happened. It almost made the whole ordeal worthwhile.

So that's my long, long story. I had a very serious symptom after a run, and it turned out to be no big deal. Happy ending. But if I had ignored that blood and something HAD been wrong... like an infection or stones or cancer... the damn thing could have killed me before I got up the nerve to check it out.

Ladies and Gentlemen, sometimes fighting for your life means going uncomfortable places. Go there anyway. Take your courage. Take your sense of humor. And take some dark glasses. You really don't want to be recognized in the elevator when your willy farts.

2 comments:

Thanks for the truly entertaining description of a process I have witnessed (when I was a medical student) and have sent patients to experience many times. I'm glad everything turned out okay. And the medical term for "willy farts", which is "pneumaturia", is no way near as descriptive. Your combination of strength and humor is what has gotten you this far, and that's a wonderful thing.